Salpingo-Oophorectomy Purpose, Risk and Diagnosis

Unilateral salpingo-oophorectomy is the surgical removal of a fallopian tube and an ovary. If both sets of fallopian tubes and ovaries are removed, the procedure is called a bilateral salpingo-oophorectomy.

Purpose

This surgery is performed to treat ovarian or other gynecological cancers, or infections caused by pelvic inflammatory disease.

Occasionally, removal of one or both ovaries may be done to treat endometriosis, a condition in which the lining of the uterus (the endometrium) grows outside of the uterus (usually on and around the pelvic organs).

The procedure may also be performed if a woman has been diagnosed with an ectopic pregnancy in a fallopian tube and a salpingostomy (an incision into the fallopian tube to remove the pregnancy) cannot be done.

If only one fallopian tube and ovary are removed, the woman may still be able to conceive and carry a pregnancy to term. If both are removed, however, the woman is rendered permanently infertile.

This procedure is commonly combined with a hysterectomy (surgical removal of the uterus); the ovaries and fallopian tubes are removed in about one-third of hysterectomies.

Until the 1980s, women over age 40 having hysterectomies routinely had healthy ovaries and fallopian tubes removed at the same time.

Many physicians reasoned that a woman over 40 was approaching menopause and soon her ovaries would stop secreting estrogen and releasing eggs.

Removing the ovaries would eliminate the risk of ovarian cancer and only accelerate menopause by a few years.

In the 1990s, the thinking about routine salpingooophorectomy began to change. The risk of ovarian cancer in women who have no family history of the disease is less than 1%.

Demographics

Overall, ovarian cancer accounts for only 4% of all cancers in women. For women at increased risk, oophorectomy may be considered after the age of 35 if childbearing is complete.

Factors that increase a woman’s risk of developing ovarian cancer include age (most ovarian cancers occur after menopause), the presence of a mutation in the BRCA1 or BRCA2 gene, the number of menstrual periods a woman has had (affected by age of onset, pregnancy, breastfeeding, and oral contraceptive use), history of breast cancer, diet, and family history.

The incidence of ovarian cancer is highest among American Indian (17.5 cases per 100,000 population), Caucasian (15.8 per 100,000), Vietnamese (13.8 per 100,000), Caucasian Hispanic (12.1 per 100,000), and Hawaiian (11.8 per 100,000) women; it is lowest among Korean (7.0 per 100,000) and Chinese (9.3 per 100,000) women.

African American women have an ovarian cancer incidence of 10.2 per 100,000 population.

Endometriosis, another reason why salpingooophorectomy may be performed, has been estimated to affect up to 10% of women.

Approximately four out of every 1,000 women are hospitalized as a result of endometriosis each year. Women 25–35 years of age are affected most, with 27 being the average age of diagnosis.

Description

General or regional anesthesia will be given to the patient before the procedure begins. If the procedure is

In a salpingo-oophorectomy, a woman’s reproductive organs are accessed through an incision in the lower abdomen, or laparoscopically (A).

Once the area is visualized, a diseased fallopian tube can be severed from the uterus and removed (B and C). The ovary can also be removed with the tube (D).

The remaining structures are stitched (E), and the wound is closed. (Illustration by GGS Inc.)

In a salpingo-oophorectomy, a woman’s reproductive organs are accessed through an incision in the lower abdomen, or laparoscopically (A).

Once the area is visualized, a diseased fallopian tube can be severed from the uterus and removed (B and C). The ovary can also be removed with the tube (D). The remaining structures are stitched (E), and the wound is closed. (
Illustration by GGS Inc.

Performed through a laparoscope, the surgeon can avoid a large abdominal incision and can shorten recovery. With this technique, the surgeon makes a small cut through the abdominal wall just below the navel.

A tube containing a tiny lens and light source (a laparoscope) is then inserted through the incision. A camera can be attached that allows the surgeon to see the abdominal cavity on a video monitor.

When the ovaries and fallopian tubes are detached, they are removed though a small incision at the top of the vagina. The organs can also be cut into smaller sections and removed.

When the laparoscope is used, the patient can be given either regional or general anesthesia; if there are no complications, the patient can leave the hospital in a day or two.

If a laparoscope is not used, the surgery involves an incision 4–6 in (10–15 cm) long into the abdomen extending either vertically up from the pubic bone toward the navel, or horizontally (the “bikini incision”) across the pubic hairline.

The scar from a bikini incision is less noticeable, but some surgeons prefer the vertical incision because it provides greater visibility while operating.

A disadvantage to abdominal salpingo-oophorectomy is that bleeding is more likely to be a complication of this type of operation.

The procedure is more painful than a laparoscopic operation and the recovery period is longer. A woman can expect to be in the hospital two to five days and will need three to six weeks to return to normal activities.

Risks and Complications

All surgery is associated with risks. Some of these risks are:

Injury to surrounding organs.

Bleeding.

Infection.

Blood clots in the legs or lungs.

Problems with the anesthesia.

The surgery does not help the problem.

Death.

Diagnosis/Preparation

Before surgery, the doctor will order blood and urine tests, and any additional tests such as ultrasound or x rays to help the surgeon visualize the woman’s condition.

The woman may also meet with the anesthesiologist to evaluate any special conditions that might affect the administration of anesthesia. A colon preparation may be done, if extensive surgery is anticipated.

On the evening before the operation, the woman should eat a light dinner, then take nothing by mouth, including water or other liquids, after midnight.

Before the Procedure

Do not take aspirin or blood thinners because it can make you bleed.

Do not eat or drink anything at least 8 hours before the surgery.

Let your caregiver know if you develop a cold or an infection.

If you are being admitted the day of surgery, arrive at least one hour before the surgery.

Arrange for help when you go home from the hospital.

If you smoke, do not smoke for at least 2 weeks before the surgery.

Procedure

After being admitted to the hospital, you will change into a hospital gown. Then, you will be given an IV (intravenous) and a medication to relax you.

Then, you will be put to sleep with an anesthetic. Any hair on your lower belly (abdomen) will be removed, and a catheter will be placed in your bladder.

The fallopian tube and ovary will be removed either through 2 very small cuts (incisions) or through large incision in the lower abdomen. The blood vessels will be clamped and tied.

After the Procedure

You will be taken to the recovery room for 1 to 3 hours until your blood pressure, pulse and temperature are stable and you are waking up.

If you had a laparoscopy, you may be discharged in several hours.

If you had a large incision, you will be admitted to the hospital for a day or two.

If you had a laparoscopy, you may have shoulder pain. This is not unusual. It is from air that is left in the abdomen and affects the nerve that goes from the diaphragm to the shoulder. It goes away in a day or two.

You will be given pain medication as necessary.

The intravenous and catheter will be removed before you are discharged.

Have someone available to take you home.

Home Care Instructions

It is normal to be sore for a week or two. Call your caregiver if the pain is getting worse or the pain medication is not helping.

Have help when you go home for a week or so to help with the household chores.

Follow your caregiver’s advice regarding diet.

Get rest and sleep.

Only take over-the-counter or prescription medicines for pain or discomfort as directed by your caregiver.

Do not take aspirin. It can cause bleeding.

Do not drive, exercise or lift anything over 5 pounds.

Do not drink alcohol until your caregiver gives you permission.

Do not lift anything over 5 pounds.

Do not have sexual intercourse until your caregiver says it is OK.

Take your temperature twice a day and write it down.

Change the bandage (dressing) as directed.

Make and keep your follow-up appointments for postoperative care.

If you become constipated, ask your caregiver about taking a mild laxative. Drinking more liquids than usual and eating bran foods can help prevent constipation.

Seek Medical Care If:

You have swelling or redness around the cut (incision).

You develop a rash.

You have side effects from the medication.

You feel lightheaded.

You need more or stronger medication.

You have pain, swelling or redness where the IV (intravenous) was placed.

Seek Immediate Medical Care If:

You develop an unexplained temperature above 100° F (37.8° C).

You develop increasing belly (abdominal) pain.

You have pus coming out of the incision.

You notice a bad smell coming from the wound or dressing.

The incision is separating.

There is excessive vaginal bleeding.

You start to feel sick to your stomach (nauseous) and vomit.

You have leg or chest pain.

You have pain when you urinate.

You develop shortness of breath.

You pass out.

Risks

Major surgery always involves some risk, including infection, reactions to the anesthesia, hemorrhage, and scars at the incision site.

Almost all pelvic surgery causes some internal scars, which in some cases can cause discomfort years after surgery.

Potential complications after a salpingo-oophorectomy include changes in sex drive, hot flashes, and other symptoms of menopause if both ovaries are removed.

Women who have both ovaries removed and who do not take estrogen replacement therapy run an increased risk for cardiovascular disease and osteoporosis.

Women with a history of psychological and emotional problems before an oophorectomy are more likely to experience psychological difficulties after the operation.

Normal results

If the surgery is successful, the fallopian tubes and ovaries will be removed without complication, and the underlying problem resolved. In the case of cancer, all the cancer will be removed.

A woman will become infertile following a bilateral salpingo-oophorectomy.

Morbidity and mortality rates

Studies have shown that the complication rate following salpingo-oophorectomy is essentially the same as that following hysterectomy.

The rate of complications differs by the type of hysterectomy performed. Abdominal hysterectomy is associated with a higher rate of complications (9.3%), while the overall complication rate for vaginal hysterectomy is 5.3%, and 3.6% for laparoscopic vaginal hysterectomy.

The risk of death is about one in every 1,000 (1/1,000) women having a hysterectomy. The rates of some of the more commonly reported complications are:

excessive bleeding (hemorrhaging): 1.8–3.4%

fever or infection: 0.8–4.0%

accidental injury to another organ or structure: 1.5–1.8%

Because of the cessation of hormone production that occurs with a bilateral oophorectomy, women who lose both ovaries also prematurely lose the protection these hormones provide against heart disease and osteoporosis.

Women who have undergone bilateral oophorectomy are seven times more likely to develop coronary heart disease and much more likely to develop bone problems at an early age than are premenopausal women whose ovaries are intact.